Caring for a COPD patient - page 2

by Simply Complicated

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Anyone know of a good website regarding caring for patients with different diagnoses? I'm specifically looking at patients with COPD. I had a situation at work a few weeks ago, regarding a patient with COPD, who ended up on a... Read More


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    [quote=SaltyNurse;4415985]The dec. in LOC has more to do with the fact that he was on the nonrebreather mask than that his level of oxygen was too high. Even if he was on a O2 mask with vents, with the severity of air-trapping that you get with end stage COPD, the only thing that would have helped prevent that would be if he stayed on the BiPAP. And even In the grand scheme of things, does it necessarily change outcomes? Not necessarily, but it's the appropriate way to do things. With these patients at some point, you're going to hit a wall. You can force the BiPAP, you can tube 'em, but at some point you'll have to keep cranking the pressure either way just to maintain reasonable gases. The next thing you know, you've got a spontaneous pneumo from a ruptured bleb, and the game is pretty much over. Yeah, you can try the ol' chest tube bit, but really by that point, you're flogging a dying horse.





    Thank you, this was very helpful! My problem was, he didn't actually have any neuro changes for me. During my 12 hour shift, he stayed pretty much the same. Which I guess I got so focused on that, I didn't see the bigger picture. Their was a lot of issues with the family, which I'm sure you know can detract with patient care. I was also focused on the cardiac issues, the drips he had going, etc. Which is why I say at the time, I thought I was doing things right. But I should have listened to the family a little closer, when they were telling me his neuro status, changed or not was not his norm. But they were throwing so many things at me, plus I'm still learning the ICU setting...

    In hindsight, I can definetely see the whole picture. I learned that it can be easy to get tunnel vision as well!
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    Having never worked ICU I can't give you much advice on the patient care aspect. However I have learned to ALWAYS listen to families, they can detect subtle changes in their loved one long before I might suspect something being amiss. We also have a number patients/families can call (basically a patient/family driven CRT) if they don't feel their concerns are being addressed. While I work nights, I can honestly say, I've never heard it use whether this is because families are not sure it is available is something to consider.
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    Quote from LouisVRN
    Having never worked ICU I can't give you much advice on the patient care aspect. However I have learned to ALWAYS listen to families, they can detect subtle changes in their loved one long before I might suspect something being amiss. We also have a number patients/families can call (basically a patient/family driven CRT) if they don't feel their concerns are being addressed. While I work nights, I can honestly say, I've never heard it use whether this is because families are not sure it is available is something to consider.

    I do try to listen to families. I have in the past caught problems because of listening to family concerns. This has taught me though, that even when the families are being a pain in the butt, to try and overlook it and listen closely.

    This particular family was very demanding, questioning every little detail. I had 4 phone calls in a 15 minute period by different family members. I had asked them to designate one person, to no avail. One of the daughters is a nurse in this healthcare system, although at a different hospital. Although it was only 1 daughter there throughout the day, she was calling the RN with every little thing. For the most part the family concerns were not really addressed until 15 minutes before my shift change, as their was only 1 family member there from 8am. Although I will admit I was getting frusturated with their family dynamics and probably let that affect me more than it should have

    They burned out every nurse who cared for this patient. They refused to let any nurse care for him who hadn't been in the ICU for 5 years or more. Most of the nurses were refusing to take him again because the family ran them so ragged. When he passed, it was a whole nother ordeal. Security almost had to be called.

    This experience has definetily taught me how to handle the family dynamics better. It is different when in ICU. I fell sorta like I went from big fish in a little pond, to little fish in a big pond. It's hard when you feel like you loose that steady footing. On M/S I was great. I feel so unsure of myself at times in ICU. But that is all a learning process!!
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    To the OP- With time, you'll get more comfortable and you won't have so much tunnel vision. And learning never ends. In fact, I think it's great that you're are making such a point of it. Get yourself some CCRN prep materials- even if you don't plan on taking the test at this time. Great coverage on a variety of important stuff. Be aware that lethargy is an early sign of neurologic decline. Not that critically ill patients are a perky bunch, but it's best to pick up on the early changes before a pt. is downright unresponsive. And it is something to have your radar out for on a CO2 retainer- especially those that won't wear the BiPAP! And I hear ya on the family dynamics. If it's a huge mob of whackadoos b*tching and fussing about every insignificant detail- a legit concern can be lost in the noise. Tactfully setting limits on these people is an art. I try to pay attention to how a variety of nurses deal with it and try to adapt some of their techniques.
    tewdles likes this.
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    well said salty!
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    Quote from nursemandalyn
    I do try to listen to families. I have in the past caught problems because of listening to family concerns. This has taught me though, that even when the families are being a pain in the butt, to try and overlook it and listen closely.

    This particular family was very demanding, questioning every little detail. I had 4 phone calls in a 15 minute period by different family members. I had asked them to designate one person, to no avail. One of the daughters is a nurse in this healthcare system, although at a different hospital. Although it was only 1 daughter there throughout the day, she was calling the RN with every little thing. For the most part the family concerns were not really addressed until 15 minutes before my shift change, as their was only 1 family member there from 8am. Although I will admit I was getting frusturated with their family dynamics and probably let that affect me more than it should have

    They burned out every nurse who cared for this patient. They refused to let any nurse care for him who hadn't been in the ICU for 5 years or more. Most of the nurses were refusing to take him again because the family ran them so ragged. When he passed, it was a whole nother ordeal. Security almost had to be called.

    This experience has definetily taught me how to handle the family dynamics better. It is different when in ICU. I fell sorta like I went from big fish in a little pond, to little fish in a big pond. It's hard when you feel like you loose that steady footing. On M/S I was great. I feel so unsure of myself at times in ICU. But that is all a learning process!!
    I know these families are awful to have to deal with... but did you ever wonder why they behave in the manner that they do? My grandma and her sister were both very sick in the hospital with end stage COPD and the care that they received was disgusting, despite being tertiary level teaching facilities in a capital city. My auntie died as a result of staff negligence in managing her COPD - largely ignoring the families consistent statement that the level of neurological change (i.e. lethargy, sleepiness, difficulty rousing) was incredibly abnormal. This, in fact, is a significant sign of CO2 retention. & the ABG was ordered to late, the transfer to ICU for BiPAP useless. When the same thing happened to my grandma six months later - I was that annoying family member because of the poor experience of my auntie. & in fact, I was justified. I arrived at my grandma's beside more than once to find the BiPAP mask strapped to her face and not connected to oxygen (i.e. no flow of air/oxygen getting to her at all.) I witnessed her in distress (cyanotic confusion) in the middle of the night, trying to tear the mask off and hurting herself - and no nurse checking on her for hours when the mask (and they get strapped tightly) was painfully squashing aspects of her face. On several occasions she was left in a urine soaked bed for a whole nursing shift. In the end I slept on the floor and cared for her myself.

    I'm not suggesting your nursing care was as I've described. I just wanted to suggest that these families aren't devils and they aren't trying to make your life hell. They simply love their sick relative. & no, that doesn't make your job easier - but at the end of the day, you go home. & they have to live with the fact that they are helpless as to whether their loved one lives or dies.
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    Quote from rachelgeorgina
    I know these families are awful to have to deal with... but did you ever wonder why they behave in the manner that they do? My grandma and her sister were both very sick in the hospital with end stage COPD and the care that they received was disgusting, despite being tertiary level teaching facilities in a capital city. My auntie died as a result of staff negligence in managing her COPD - largely ignoring the families consistent statement that the level of neurological change (i.e. lethargy, sleepiness, difficulty rousing) was incredibly abnormal. This, in fact, is a significant sign of CO2 retention. & the ABG was ordered to late, the transfer to ICU for BiPAP useless. When the same thing happened to my grandma six months later - I was that annoying family member because of the poor experience of my auntie. & in fact, I was justified. I arrived at my grandma's beside more than once to find the BiPAP mask strapped to her face and not connected to oxygen (i.e. no flow of air/oxygen getting to her at all.) I witnessed her in distress (cyanotic confusion) in the middle of the night, trying to tear the mask off and hurting herself - and no nurse checking on her for hours when the mask (and they get strapped tightly) was painfully squashing aspects of her face. On several occasions she was left in a urine soaked bed for a whole nursing shift. In the end I slept on the floor and cared for her myself.

    I'm not suggesting your nursing care was as I've described. I just wanted to suggest that these families aren't devils and they aren't trying to make your life hell. They simply love their sick relative. & no, that doesn't make your job easier - but at the end of the day, you go home. & they have to live with the fact that they are helpless as to whether their loved one lives or dies.


    You are very right in that. I try to remind myself of that on a regular basis when dealing with difficult families. But it is different when they have a sense of entitlement about themselves. I am usually pretty good with the difficult families, I can handle them. I was upset with this one, because I was bending over backwards for them, trying so hard to keep them informed. It wasn't like I ignored there concerns. I talked with the doc, I was in his room CONSTANTLY. Then they turned around and basically told the supervisor that I ignored them and him. Which was so not the case. He was here for a couple weeks. The thing was because one was a nurse, and worked for this system.. they expected special treatment.

    But you are right. I am definetely walking away from this with a learning experience. It's just that they also need to work with us. When we politely ask them to deisgnate a contact person to talk with the nurse, and they ignore our request, etc....
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    [quote=nursemandalyn;4417860]
    Quote from SaltyNurse

    Thank you, this was very helpful! My problem was, he didn't actually have any neuro changes for me. ... But I should have listened to the family a little closer, when they were telling me his neuro status, changed or not was not his norm. But they were throwing so many things at me, plus I'm still learning the ICU setting...

    In hindsight, I can definetely see the whole picture. I learned that it can be easy to get tunnel vision as well!

    Live and learn. And always,ALWAYS listen to the family. They know your patient far better than anyone in the ICU
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    thanks for the links!!


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